A Matched Case-Control Study on the Association Between Colds, Depressive Symptoms during Pregnancy and Congenital Heart Disease in Northwestern China

Parental Smoking and the Risk of Birth Defects in Offspring in China: A Systematic Review and meta-Analysis

OBJECTIVE

A meta-analysis of case-control studies was conducted to assess the risk of birth defects in offspring in China associated with maternal active and passive smoking and paternal smoking.

METHODS

Four electronic databases were searched for qualified research up to December 2023. A Random-effect model or fixed-effect model was used to calculate the overall comprehensive risk estimates; and the relationship between parental smoking and the risk of birth defects in different periods of pregnancy. Subgroup and sensitivity analyses were performed to explore possible sources of heterogeneity.

RESULTS

Sixty-two qualified studies involving 137,574 cases and 8,770,837 controls were included. Overall, maternal active smoking (OR = 2.19; 95% confidence interval (CI): 1.72-2.79; p < 0.01) and passive smoking (OR = 2.59,95% CI: 2.24-2.99; p < 0.01) as well as paternal active smoking (OR = 1.47,95% CI: 1.34-1.62; p < 0.01) were significantly associated with birth defect risk. The sources of heterogeneity were explored by subgroup analysis. Subgroup analysis showed that the risk of congenital heart disease in offspring was increased in paternal and maternal active smoking (OR = 2.97, 95% CI: 2.01-4.39; OR = 1.51, 95% CI: 1.30-1.74), respectively. Sensitivity analysis yielded consistent results.

CONCLUSION

Maternal active and passive smoking and paternal active smoking are risk factors for birth defects in offspring. Parents should be encouraged to quit smoking during the perinatal period and pregnancy.

Risk-prediction nomogram for congenital heart disease in offspring of Chinese pregnant women

BACKGROUND

The identification and assessment of environmental risks are crucial for the primary prevention of congenital heart disease (CHD). We were aimed to establish a nomogram model for CHD in the offspring of pregnant women and validate it using a large CHD database in Northwest China.

METHODS

A survey was conducted among 29,204 women with infants born between 2010 and 2013 in Shaanxi province, Northwest China. Participants were randomly assigned to the training set and to the validation set at a ratio of 7:3. The importance of predictive variables was assessed using random forest. A multivariate logistic regression model was used to construct the nomogram for the prediction of CHD.

RESULTS

Multivariate analyses revealed that the gravidity, preterm birth history, family history of birth defects, infection, taking medicine, tobacco exposure, pesticide exposure and singleton/twin pregnancy were significant predictive risk factors for CHD in the offspring of pregnant women. The area under the receiver operating characteristic curve for the prediction model was 0.716 (95% CI: 0.671, 0.760) in the training set and 0.714 (95% CI: 0.630, 0.798) in the validation set, indicating moderate discrimination. The prediction model exhibited good calibration (Hosmer-Lemeshow χ2 = 1.529, P = 0.910).

CONCLUSIONS

We developed and validated a predictive nomogram for CHD in offspring of Chinese pregnant women, facilitating the early prenatal assessment of the risk of CHD and aiding in health education.

The modification of meteorological factors on the relationship between air pollution and periodontal diseases: an exploration based on different interaction strategies

We aimed to characterize the association between air pollutants exposure and periodontal diseases outpatient visits and to explore the interactions between ambient air pollutants and meteorological factors. The outpatient visits data of several large stomatological and general hospitals in Hefei during 2015-2020 were collected to explore the relationship between daily air pollutants exposure and periodontal diseases by combining Poisson's generalized linear model (GLMs) and distributed lag nonlinear model (DLNMs). Subgroup analysis was performed to identify the vulnerability of different populations to air pollutants exposure. The interaction between air pollutants and meteorological factors was verified in both multiplicative and additive interaction models. An interquartile range (IQR) increased in nitrogen dioxide (NO2) concentration was associated with the greatest lag-specific relative risk (RR) of gingivitis at lag 3 days (RR = 1.087, 95% CI 1.008-1.173). Fine particulate matter (PM2.5) exposure also increased the risk of periodontitis at the day of exposure (RR = 1.049, 95% CI 1.004-1.096). Elderly patients with gingivitis and periodontitis were both vulnerable to PM2.5 exposure. The interaction analyses showed that exposure to high levels of NO2 at low temperatures was related to an increased risk of gingivitis, while exposure to high levels of NO2 and PM2.5 may also increase the risk of gingivitis and periodontitis in the high-humidity environment, respectively. This study supported that NO2 and PM2.5 exposure increased the risk of gingivitis and periodontitis outpatient visits, respectively. Besides, the adverse effects of air pollutants exposure on periodontal diseases may vary depending on ambient temperature and humidity.

Weighted gene co-expression identification of CDKN1A as a hub inflammation gene following cardiopulmonary bypass in children with congenital heart disease

Background

Congenital heart disease (CHD) is the most common type of birth defect. Most patients with CHD require surgery, and cardiopulmonary bypass (CPB) is the most common surgery performed.

Methods

The present study utilized weighted gene co-expression network analysis (WGCNA) to identify key inflammation genes after CPB for CHD. The GSE132176 dataset was downloaded from the Gene Expression Omnibus(GEO) database for WGCNA to identify the modules closely related to clinical traits. Disease enrichment, functional annotation and pathway enrichment were performed on genes in the module closely related to clinical traits using Enrichr and Metascape. Immune infiltration analysis was also performed on the training dataset using CIBERSORT. Finally, we identified hub genes using high gene significance (GS), high module members (MMs) and Cytoscape, and we verified the hub genes using an independent dataset and Western blot analysis.

Results

WGCNA showed that the brown module with 461 genes had the highest correlation to CHD after CPB. Functional annotation and pathway enrichment analysis were performed using Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analyses, which showed that genes in the brown module were enriched in inflammation-related pathways. In the disease enrichment analysis, genes in the brown module were enriched for inflammatory diseases. After the 30 most highly associated brown intramodular genes were screened, a protein-protein interaction network was constructed using the STRING online analysis website. The protein-protein interaction results were then calculated using 12 algorithms in the cytoHubba plugin of Cytoscape software. The final result showed that CDKN1A was the fundamental gene of post-CPB for CHD. Using another independent validation dataset (GSE12486), we confirmed that CDKN1A was significantly differentially expressed between preoperative and postoperative CPB (Wilcoxon, P = 0.0079; T-test, P = 0.006). In addition, CDKN1A expression was elevated in eosinophils, neutrophils, memory CD4 T cells and activated mast cells. Western blot analysis showed that the expression of CDKN1A protein was significantly higher postoperative CPB than preoperative CPB. Moreover, CDKN1A was mainly related to inflammation.

Conclusion

In summary, we found a relationship between CDKN1A and inflammation after CPB for congenital heart disease by WGCNA, experiments and various bioinformatics methods. Thus, CDKN1A maybe serve as a biomarker or therapeutic target for accurate diagnosis and treatment of inflammation after CPB in the future.

The effect and its critical window for ambient temperature and humidity in pregnancy on term low birth weight

As common meteorological factors in daily life, there is limited evidence for the effect of ambient temperature and humidity during pregnancy on the risk of term low birth weight. Furthermore, little is known about the interaction of ambient temperature and humidity on TLBW. The objective of the study was to explore the effect of ambient temperature, humidity during pregnancy, and their interaction on the risk of TLBW and, moreover, to identify exposure critical window. We recruited 6640 infants and their mothers to build a birth cohort study in Jinan City, China, from January 2018 to December 2019. The associations between temperature and humidity during pregnancy and TLBW were estimated by generalized additive model, logistic regression model, and interaction analysis, and the critical window was identified by the distributed lag non-linear model. The incidence of TLBW was 1.36% for the infants in the birth cohort. TLBW was related to the low level of temperature and humidity in the whole pregnancy, compared with the moderate level and the adjusted ORs were 4.44 (1.65-11.42) and 6.23 (1.92-21.39), respectively. The indicators of the interaction analysis of temperature and humidity were not statistically significant. For the low level of humidity, the association with TLBW was statistically significant at first to sixth gestational weeks, and the maximum OR in male infants (3.95, 1.70-9.16) was higher than that in females (1.96, 1.06-3.63). For the low level of temperature, we failed to find significant association with TLBW at each gestational week. The low level of temperature and humidity during pregnancy could increase the risk of TLBW. There was no statistical interaction between temperature and humidity on TLBW. Moreover, the early stage of pregnancy was the critical window for humidity exposure, in which the boys had a greater effect.

Maternal psychological distress, education, household income, and congenital heart defects: a prospective cohort study from the Japan environment and children's study

Background

The influence of maternal psychological distress on infant congenital heart defects (CHDs) has not been thoroughly investigated. Furthermore, there have been no reports on the combined effect of maternal psychological distress and socioeconomic status on infant CHDs. This study aimed to examine whether maternal psychological distress, socioeconomic status, and their combinations were associated with CHD.

Methods

We conducted a prospective cohort study using data from the Japan Environment and Children’s Study, which recruited pregnant women between 2011 and 2014. Maternal psychological distress was evaluated using the Kessler Psychological Distress Scale in the first trimester, while maternal education and household income were evaluated in the second and third trimesters. The outcome of infant CHD was determined using the medical records at 1 month of age and/or at birth. Crude- and confounder-adjusted logistic regression analyses were performed to evaluate the association between maternal psychological distress and education and household income on infant CHD.

Results

A total of 93,643 pairs of mothers and infants were analyzed, with 1.1% of infants having CHDs. Maternal psychological distress had a significantly higher odds ratio in the crude analysis but not in the adjusted analysis, while maternal education and household income were statistically insignificant. In the analysis of the combination variable of lowest education and psychological distress, the P for trend was statistically significant in the crude and multivariate model excluding anti-depressant medication, but the significance disappeared in the full model (P = 0.050).

Conclusions

The combination of maternal psychological distress and lower education may be a possible indicator of infant CHD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04001-2.

Association of Short and Long Interpregnancy Intervals with Adverse Birth Outcomes: Evidence from a Cross-Sectional Study in Northwest China

Purpose

To analyze the effects of a short interpregnancy interval (IPI) (<6 months) and a long IPI (>120 months) on neonatal adverse birth outcomes including low birth weight (LBW), small for gestational age (SGA), preterm birth (PTB), and birth defects in Shaanxi Province.

Patients and Methods

A stratified multistage random sampling method was used to recruit participants who gave birth between 2010 and 2013 in Shaanxi province. A self-designed questionnaire was used to collect the information of the participants. With the confounding factors controlled, the generalized linear model (GLM) was used to investigate the association between IPI and neonatal birth outcomes. The restricted cubic spline (RCS) function was used to evaluate the dose–response relationship between IPI and birth outcomes.

Results

A total of 13,231 women were included. The prevalence of LBW, SGA, PTB, and birth defects was 3.24%, 12.96%, 2.93%, and 2.12%, respectively. GLM showed that a short IPI (<6 months) was associated with a higher risk of SGA (RR=1.25, 95% CI: 1.04–1.52) and birth defects (RR=2.55, 95% CI: 1.45–4.47), and a long IPI (≥120 months) was associated with a higher risk of LBW (RR=1.54, 95% CI: 1.01–2.34) and PTB (RR=1.73, 95% CI: 1.08–2.76) than an IPI of 18–23 months. The RCS showed that LBW, SGA, and PTB demonstrated a j-shaped relationship with IPI (P for overall association < 0.001 for these three birth outcomes), and birth defects (P for overall association <0.001) had an inversely non-linear relationship with IPI.

Conclusion

Both short and long IPIs are associated with an increased risk of adverse birth outcomes.

Maternal fever during preconception and conception is associated with congenital heart diseases in offspring: An updated meta-analysis of observational studies

BACKGROUNDS

Many studies have evaluated the effect of maternal fever on the development risk of congenital heart diseases (CHDs) in offspring, but the findings were inconsistent. Furthermore, a complete overview of the existing data was also missing. Therefore, we intend to provide updated epidemiologic evidence to estimate the association between maternal fever and the risk of overall CHDs and specific CHD phenotypes in offspring.

METHODS

Pubmed, Embase, and Web of Science were searched through March 2020 to identify eligible studies that assessed the association between maternal fever and CHDs risk in offspring. The summary risk estimates were calculated using random-effects models. Potential heterogeneity source was explored by subgroup analyses and potential publication bias was assessed by Begg funnel plots and Begg rank correlation test.

RESULTS

Sixteen studies involving 31,922 CHDs cases among 183,563 participants were included in this meta-analysis. Overall, mothers who had a fever experience during preconception and conception periods had a significantly higher risk of overall CHDs in offspring (odds ratio [OR] = 1.45, 95% confidence interval [CI]: 1.21-1.73) when compared with those who did not have a fever experience. For specific CHD phenotypes in offspring, a statistically significant association was found between maternal fever and risk of conotruncal defects (CTD) (OR = 1.38, 95%CI: 1.01-1.89), atrial septal defects (ASD) (OR = 1.48, 95% CI: 1.01-2.17), transposition of the great vessels (TGA) (OR = 1.81, 95% CI: 1.14-2.88), and right ventricular outflow tract obstruction (RVOTO) (OR = 1.66, 95% CI: 1.04-2.65). Relevant heterogeneity moderators have been identified by subgroup analyses, and sensitivity analyses yielded consistent results.

CONCLUSIONS

Although the role of potential bias and evidence of heterogeneity should be carefully evaluated, our review indicates that maternal fever is significantly associated with the risk of CHDs in offspring, which highlights that preventing maternal fever during the preconception and conception periods play an important role in decreasing the risk of CHDs in offspring. However, given the limited number of current case-control studies, larger-sample prospective studies are required to further confirm our results. Besides, due to the underlying mechanisms between maternal fever and the risk of specific CHD phenotypes in offspring are still unreported, more research is needed to explore the possible mechanisms.

Geographical variations in maternal lifestyles during pregnancy associated with congenital heart defects among live births in Shaanxi province, Northwestern China

In this study, we aimed to explore regional differences in maternal lifestyle during pregnancy related to congenital heart defects (CHD) in Shaanxi province, Northwestern China. A large-scale epidemiologic survey of birth defects among infants born during 2010–2013, was conducted in Shaanxi province. Non-spatial and geographic weighted logistic regression models were used for analysis. The spatial model indicated that passive smoking frequency was positively associated with CHD for 43.3% of participants (P < 0.05), with the highest OR in North Shaanxi and the lowest in South Shaanxi. Approximately 49.2% of all mothers who ever drink tea were more likely to have an infant with CHD (P < 0.05), with the highest OR values observed in North and Central Shaanxi. Additionally, maternal alcohol intake frequency ≥ 1/week was significantly correlated with CHD among about 24.7% of participants (P < 0.05), with OR values ranging from 0.738 (Central Shaanxi) to 1.198 (North Shaanxi). The rates of unhealthy maternal lifestyles during pregnancy associated with CHD differed in various areas of the province. The role of geographical variations in these factors may provide some possible clues and basis for tailoring site-specific intervention strategies.

Interactions between climate factors and air quality index for improved childhood asthma self-management

BACKGROUND

Daily air quality index (AQI) forecast can provide early warning information, and it is not clear whether it is appropriate for childhood asthma hospitalizations (CAHs). Furthermore, little is known about the effects of AQI on CAHs, as well as the interactions between temperature, humidity and AQI.

METHODS

We collected 32,238 cases in Hefei from 2013 to 2016 and estimated the association between daily CAHs and AQI by combining the Poisson Generalized Linear Models (PGLMs) with the Distributed Lag Nonlinear Models (DLNMs). The interaction between AQI and temperature was tested by stratifying AQI and temperature, as well as humidity.

RESULTS

AQI was associated with an increased risk of hospitalizations for childhood asthma. The adverse effect first appeared on the 3rd day, with the RR of 1.011 (95%CI: 1.000-1.023) and continued until the 19th day of lag (RR = 1.010, 95%CI: 1.001-1.020). In the subgroup analysis, the male and pre-school children were more sensitive to AQI, and there are seasonal differences in the effects of AQI on CAHs. Besides, in a stratified analysis with an AQI of 150, we found synergies between temperature, humidity and AQI. The interaction relative risk (IRR) and relative excess risk due to interaction (RERI) for the interaction between temperature and AQI were 1.157 (95%CI: 1.029-1.306) and 0.122 (95%CI: 0.022-0.223) respectively. For the humidity, the IRR and RERI were 1.090 (95%CI: 1.056-1.206) and 0.083 (95%CI: 0.083-0.143) respectively. Exploring different subgroups in the interaction analyses, it was worth noting that female and pre-school children were more sensitive to the interaction between AQI and temperature, while school-age children were more sensitive to the interaction between AQI and humidity.

CONCLUSIONS

The study found that not only AQI can significantly increase the risk of CAHs, but also that under the context of climate change, temperature and humidity have a synergistic effect on AQI, suggesting that considering only the warning information of air pollution is not enough to strengthen the prevention of childhood asthma hospitalization.

[Association between maternal alcohol consumption and risk of congenital heart disease in offspring: a Meta analysis]

OBJECTIVE

To study the association between maternal alcohol consumption and the risk of congenital heart disease (CHD) in offspring.

METHODS

PubMed, Cochrane Library, Web of Science, Google Scholar, China Biology Medicine disc, Wanfang Database, CNKI Database, and Weipu Database were searched for the articles on the association between maternal alcohol consumption and congenital heart disease in offspring. These articles were published up to November 30, 2019. A random effects model or a fixed effects model was used for the pooled analysis of the results of each study, and then the pooled effective value and its 95%CI were calculated. A subgroup analysis was performed to explore heterogeneous regulators. Funnel plots and an Egger's test were used to assess publication bias.

RESULTS

A total of 4 409 articles were searched, and 55 articles were finally included in this analysis, among which there were 6 cohort studies and 49 case-control studies. The Meta analysis showed heterogeneity across all studies (I²=74%, P<0.01). The random effects model showed that maternal alcohol consumption was associated with CHD in offspring, with an OR of 1.18 (95%CI: 1.09-1.28). The Egger's test showed a certain degree of publication bias (P<0.05), and after adjustment, the pooled OR of CHD in offspring was 1.10 (95%CI: 1.01-1.21).

CONCLUSIONS

Maternal alcohol consumption may increase the risk of CHD in offspring.